Background: The lymphatic system consists of the superficial and deep lymphatic system. Several diagnostic methods are used to assess the lymphatic system. Lymphoscintigraphy and indocyanine green lymphography are widely applied, both showing disadvantages, such as a poor resolution and lack of field of view. Magnetic resonance lymphography (MRL) shows satisfactory temporal and spatial resolution. The aim of this study was to assess both the superficial and deep lymphatic system in the upper extremity of healthy subjects, using an MRL protocol. Methods and Results: Ten healthy volunteers underwent an MRL examination, using a three Tesla MRI unit. Water-soluble gadolinium was used as a contrast agent. MRL images were evaluated by an experienced radiologist on image quality, enhancement of veins and lymphatic vessels, and characteristics of the latter. Overall image quality was good to excellent. In all subjects, veins and lymphatic vessels could be distinguished. Superficial and deep lymphatic vessels were seen in 9 out of 10 subjects. Lymphatic vessels with a diameter between 0.9 and 4.3 mm were measured. Both veins and lymphatic vessels showed their characteristic appearance. Enhancement of veins was seen directly after contrast agent injection, which decreased over time. Lymphatic vessel enhancement slowly increased over time. Mean total MRL examination (room) time was 110 minutes (81 minutes scan time). Conclusions: The MRL protocol accurately visualizes both deep and superficial lymphatic vessels showing their characteristic appearances with high spatial resolution, indicating the MRL can be of value in diagnosing and staging peripheral lymphedema.

Acellular dermal matrices (ADM) have been suggested to allow for different approaches and reduce the risk of postoperative complications in implant-based breast surgery. Surgeons seem to embrace ADMs around the world, although a lack of consistent evidence regarding the factors that increase the risk of major postoperative complications remains. To develop and internally validate a model to predict the risk of a major postoperative complication in breast reconstructive surgery with and without an ADM. The DBIR is an opt-out registry that holds characteristics of all breast implant surgeries in the Netherlands since 2015. Using a literature-driven preselection of predictors, multivariable mixed-effects logistic regression modelling was used to develop the prediction model. A total of 2939 breasts were eligible, of which 11% underwent an ADM-assisted procedure (single-stage or two-stage). However, 31% underwent a two-stage procedure (with or without the use of ADM). Of all breasts, 10.2% developed a major postoperative complication. Age (OR 1.01), delayed timing (OR 0.71), and two-stage technique (OR 4.46) were associated with the outcome. The data suggest that ADM use was not associated with a major postoperative complication, while two-stage reconstructions were strongly associated with an increased risk of major complications. Despite these findings, ADMs are not as popular in the Netherlands as in the USA. The predictive capabilities of the developed model are mediocre to poor, but because of the above findings, we believe that the role of the two-stage technique as a golden standard should be put up for debate.

Finger arthroplasty is commonly used to treat pain in the finger joints due to osteoarthritis or rheumatoid arthritis. Despite the procedure having existed for a relatively long time, it is still unknown which characteristics influence implant survival. The Dutch Arthroplasty Registry (LROI) is one of the 4 registries worldwide registering finger arthroplasties. This study aimed to investigate impact factors for implant survival regarding finger joint arthroplasty and assess registration completeness using the national healthcare claims database to compare.

The use and effect of most infection control measures (ICMs) in breast implant surgery are still debated, likely resulting in undesired variation in current practices. This study investigated the relationship between the number and combinations of ICMs used and the infection-related revision incidence after breast implant surgery. Additionally, national variation between Dutch healthcare institutions in ICM use was evaluated. For this multicentre, population-based study, all patients who received a primary breast implant or tissue expander for breast augmentation or reconstruction between 2015 and 2019 were identified from the Dutch Breast Implant Registry. Seven prospectively collected ICMs were investigated: preoperative antibiotics, implant and/or pocket irrigation, glove change, nipple guards, insertion sleeve, postoperative drains, and postoperative antibiotics. This study included 52,415 implants (85% augmentation, 15% reconstruction).The median (IQR) number of ICMs used was 3 (3-4) for augmentation and 4 (4-5) for reconstruction. Median follow-up was 30 months for augmentation and 34 months for reconstruction. Infection-related revision incidence was 0.1% for augmentation and 2.1% for reconstruction. Most infection-related revisions occurred within 2 months for augmentation and 2.5 months for reconstruction. The impact of ICM use on infection-related revision incidence remained unclear, given its low incidence. A significant variation was observed between institutions in the use of postoperative antibiotics and drains. Although the use of different ICMs varied considerably between institutions, the infection-related revision incidence after breast implant surgery was generally low. Most surgeons used four ICMs for breast reconstruction and three ICMs for breast augmentation. Further studies on the causes and effects of the observed variation are needed.

The treatment of carpal- and carpometacarpal arthritis using arthroplasty is becoming more common in hand surgery. Trapeziectomy is regarded as the standard treatment. Complications of trapeziectomy like thumb shortening and reduced mobility may be less common in arthroplasty. However, arthroplasty may cause implant failure and possible revision surgery. The Dutch arthroplasty registry (LROI) has been registering hand and wrist implants since 2016. Data from the LROI from 2017 to 2022 was used aiming to assess descriptive data regarding carpal- and carpometacarpal arthroplasty to demonstrate associations between arthroplasty and possible risk factors. Furthermore, this study aims to demonstrate the potential of the LROI and assess registration completeness. The registry included 178 primary first carpometacarpal arthroplasties, along with 23 revision arthroplasties. About 69.1 % of primary surgeries was performed by plastic surgeons, the others by orthopedic surgeons. Primary surgery was performed in women in 74.2 % of cases. Revision arthroplasty was performed as often by plastic surgeons, as by orthopedic surgeons. Too few carpal implants were registered to assess these types of implants. Comparing the registrations in the LROI with the national healthcare claims database showed a completeness of 9.04 % for plastic surgeons, and 30.39 % for orthopedic surgeons. This low registration completeness did not allow for any definitive conclusions to be drawn. However, this study shows large-scale registries may provide useful insights, possibly guiding clinical decision-making. To improve registration completeness, efforts should be made to facilitate registration as quick as possible, while also boosting awareness among physicians that perform carpal- and carpometacarpal arthroplasty.

Background: Osteoarthritis of the hand and wrist is common and can have a significant impact on quality of life. Since the carpus consists of multiple bony structures, osteoarthritis can exist in many forms. Arthroplasty using implants has become the standard treatment for many larger joints. In carpal arthroplasty, many implants exist. To determine the most suitable implant in each individual patient, knowledge of the possibilities is important. This article aims to provide an overview of the more commonly used implants in carpal arthroplasty. Methods: This narrative review describes all types of carpal implants, namely, total wrist implants, first carpometacarpal implants, the Amandys® implant, the Pyrocardan® disc, pyrocarbon capitate resurfacing implants, the adaptive proximal scaphoid implant, and total carpal replacement. A literature search was conducted separately for each implant. All studies investigating implant performance were included. Results: Naturally, each implant showed different results. Implant arthroplasty is most often compared to either arthrodesis or resection arthroplasties. For joint replacing implants like total wrist implants or first carpometacarpal implants, the use of joint replacing implants seems to be beneficial in certain populations. Joint resurfacing implants show similar functional results to the comparable non-implant options. However, research on these implants is less prevalent. Regarding all implants, complication rates seemed either similar to or in favor of non-implant options. Almost no studies found a lower complication rate for implant usage. Conclusions: Carpal implants are a valid option in carpal osteoarthritis. Implants seem to perform comparably to non-implant options. Careful patient selection is required, especially since implants may carry a higher risk of complications.